Polycystic Ovarian Syndrome Awareness Month

Among many other diseases and disorders, September is also the month to spread awareness regarding an invisible, but just as serious medical condition called Polycystic Ovarian Syndrome - or PCOS, for short. PCOS is an extremely common problem in women's health, and is the most common hormonal disorder among women of reproductive age.

The name itself, is a tad misleading, as most people tend to believe that this syndrome means that a woman only has cysts on her ovaries, when really it is so much more in depth than that. In fact, a woman doesn't need to have cysts at all to get diagnosed with PCOS. One of the biggest misconceptions of the disease is that a woman diagnosed with PCOS only suffers from painful cysts or cramping during or before her menstrual cycle, when there are a plethora of symptoms and imbalances that a woman with this condition struggles with.

This article hopes to shed some light into what Polycystic Ovarian Syndrome is, bring awareness for those who are silently struggling, and debunk any myths surrounding the condition itself.

What Is Polycystic Ovarian Syndrome?

PCOS is a health condition that affects approximately 10 million around the world. Many times, this diagnosis is difficult to recognize, and can take years to correctly diagnose.

The exact cause of PCOS is unknown, but it is considered to be a hormonal problem. Genetics and environmental factors are believed to be involved in the development of PCOS, thus making it the leading cause of female infertility. PCOS is not only responsible for fertility issues, but includes a number of symptoms that can greatly affect the body, physically and emotionally.

Despite the name though, many women do not have cysts on their ovaries. In 2013, an independent panel of experts recommended to the National Institute of Health that the name be changed because it misrepresents the illness, and hinders patient care and research efforts.

There are three specific hormones that are involved in PCOS, and they are called: androgens, insulin, and progesterone. Androgens are also referred to as "male hormones." Every female makes these, but there are often higher levels of androgens in women with PCOS. The excess androgens are responsible for many PCOS symptoms, including: acne, unwanted hair, thinning hair, and irregular menstrual cycles. 

The insulin hormone allows the body to absorb glucose - or, blood sugar - into cells for energy. In PCOS, the body isn't as responsive to insulin as it should be. This can lead to elevated blood sugar levels and cause the body to make more insulin. Having too much insulin can cause the body to make more androgens. 

Lastly, the progesterone hormone causes regular menstrual cycles. A lack of progesterone contributes to the irregularity of menstruation.

Symptoms of PCOS

Symptoms of PCOS may begin shortly after puberty, but can also develop during the later teen years into early adulthood. This is when PCOS most often goes undiagnosed because symptoms may be attributed to other causes, or go unnoticed.

Women with PCOS typically have irregular or missed menstrual cycles as a result of not ovulating. Although some women may develop cysts on their ovaries, many women do not.

Other symptoms of PCOS include:

- Weight gain: About half of women with PCOS will have weight gain and obesity that is difficult to manage and take control of.

- Fatigue: Many women with PCOS report increased fatigue and low energy. Fatigue is actually one of the leading symptoms of PCOS. Related issues, such as poor sleep, low vitamin B12 levels, or underactive thyroid may also contribute to the feeling of fatigue.

- Hirsutism: Or, unwanted hair growth. Areas affected by excess hair growth may include the face, arms, back, chest, thumbs, toes, and abdomen. The excess hair growth related to PCOS is due to hormonal changes in androgens.

- Thinning Hair: Hair loss is extremely common in women with PCOS. This too is also related to the hormonal imbalance of extra male hormones in the body.

- Infertility: PCOS is the leading cause of female infertility. However; not every women with PCOS is the same. Although some women may need the assistance of fertility treatments, others are able to conceive naturally. 

- Acne: Hormonal changes related to androgens can lead to acne problems. Other skin changes, such as the development of skin tags and darkened patches of skin are also related to PCOS.

- Mood Changes: Having PCOS can increase the likelihood of mood swings, depression, and anxiety. Every woman is different in the way she handles these changes, or how often these mood swings occur, but they all are unavoidable, and unpredictable.

- Headaches: Because the hormones are constantly changing, headaches are often prompted.

- Sleep Problems: Women with PCOS often report problems in their sleeping patterns. Some women experience insomnia, while others just experience poor sleep. PCOS has also been linked to a sleep disorder called sleep apnea.

- Pelvic Pain: Pelvic pain may occur with menstruation, along with heavy bleeding. However, it may also occur when a women isn't bleeding, as well.

Diagnosing PCOS

There isn't one special test that can diagnose PCOS. Your doctor will start by asking you questions about your medical history, symptoms, irregular or missed menstrual cycles, weight changes, hair changes, or acne changes. Your doctor will also ask about your family's medical history. Then, they will begin a complete physical exam, including checking your weight and vitals. A number of lab tests may also be required, including those to check your blood sugar and androgen levels. Lastly, a sonogram may also be done to evaluate the ovaries.

**NOTE: If you have a sonogram done, and no cysts are shown, that does not rule out PCOS. Remember, some women may not have cysts, but still have the condition. Also, a sonogram will only show cysts of a certain size. If you have very minuscule cysts, they most likely will not appear on a sonogram. 

In any event, these tests help to make a diagnosis of PCOS and exclude other causes for the symptoms. Your primary doctor may also refer you to a hormone specialist or endocrinologist to help direct the work-up needed to rule out other conditions, and confirm the diagnosis of PCOS.

Treatment and Curing PCOS

Unfortunately, as of now there isn't a cure for PCOS, but there are many ways to treat, decrease, or eliminate PCOS symptoms and feel better. Your doctor may offer various medications that can treat symptoms, such as Metformin, Letrozole, and Clomid.

If a woman is not seeking to become pregnant, hormonal birth control is a standard treatment. Birth control pills regulate menstruation and improve excess hair growth and acne by lowering androgen levels, and protecting the endometrium against abnormal cell growth. Speak with your doctor about what method of birth control may be right for you. Older types of birth control pills have a lower risk for dangerous blood clots, and are preferable over new types of birth control pills.

Although not approved by the FDA for treatment of PCOS, many doctors prescribe metformin for PCOS patients. Metformin is a medication that makes the body more sensitive to insulin. This can help lower elevated blood glucose levels, insulin levels, and androgen levels. People who use metformin may lose some weight as well. Metformin can improve menstrual patterns, but metformin doesn't help as much for unwanted, excess hair. 

Many women who are diagnosed with PCOS are often automatically prescribed metformin. However; it is important to have a reason for taking metformin, and not be on it just because of a PCOS diagnosis. Discuss with your doctor the reasons for being prescribed metformin, and whether it is providing a benefit to you. 

If a women is seeking to become pregnant, there are fertility treatments available to help women conceive. Clomiphene, or Clomid, is an oral medication that is the most common treatment to induce ovulation. The use of both metformin and Clomid has the same fertility results as Clomid alone. A benefit is that metformin may help to reduce the risk for ovarian hyperstimulation syndrome during fertility treatments.

Other treatments to stimulate ovulation include another oral medication called Letrozole, and gonadotrophins, which are hormones that are given by injection. In vitro fertilization (or IVF) and in vitro maturation (or IVM) may also be other fertility treatment options.

Lifestyle measures to achieve a weight loss of five to ten percent in overweight women can help regulate ovulation and menstruation. Although the basic approach of nutrition is needed, it can be more challenging to lose weight and maintain that weight loss with PCOS. However, studies show that even just a little bit of weight reduction and exercise can improve insulin sensitivity.

Medicines that curb androgen levels are another common treatment used for PCOS, although they aren't officially FDA approved for PCOS treatment. By lowering androgen levels, many patients have significant improvements with androgen related symptoms, such as excess hair.

More natural methods are also being studied for women with PCOS. Vitamins, supplements, and other holistic treatments are becoming popular among women with PCOS. Researchers are still studying the effectiveness of these treatments, but some popular treatments include: cinnamon, myo-inositol, vitamin D, B complex vitamins, and acupuncture.

PCOS Health Complications

  

Like most medical conditions, PCOS is not without additional complications to other parts of your body. Aside from fertility problems, complications from PCOS include:

- Risk for developing insulin resistance, prediabetes, and diabetes 

- Abnormal and increased cholesterol, and triglyceride levels

- Heart Disease 

- Stroke 

- Endometrial Cancer

- Ovarian Cancer

- Obesity 

- Sleep Apnea 

It's important to discuss all of these possible complications with your doctor. If you suspect that you have PCOS, don't suffer in silence. It may be an invisible illness, but it is just as real. Speak up and speak out about your health. Find a compassionate physician who knows and understands PCOS. There are different health care providers who may diagnose and provide the right care for PCOS or PCOS related conditions, and they include:

- Gynecologist

- Primary Care Doctor

- Medical Endocrinologist - a hormone specialist that is generally considered the specialist for PCOS

- Reproductive Endocrinologist - a fertility specialist

- Psychologist and/or Psychiatrist - to help cope with the depressive and anxious states that PCOS brings

- Dietician

Women often see more than one health provider for PCOS related issues, and that is perfectly normal. If you're undecided on where to begin, start with finding an endocrinologist. They have all of the necessary lab tests that you will need to properly diagnose you and treat you.